5·12汶川大地震老年人脊柱骨折临床特点分析
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摘要
目的分析5·12汶川大地震老年脊柱骨折类型构成情况及临床特点。方法将119例伤员按照年龄分为两组,<60岁组78例,≥60岁组41例。收集其骨折类型、神经损害程度、复合伤及多个部位脊柱骨折的有关数据,分析发生地震伤时老年人与中青年人脊柱骨折的临床特点。结果≥60岁组骨折类型以压缩骨折最多见(占所有骨折类型的48.8%),其次是爆裂骨折(占46.3%),仅有2例骨折脱位,未发现有安全带骨折,其骨折类型的总体构成情况与<60岁组相比差异有显著性意义;10例伤员伴发了较严重的神经损害(24.4%),29例伴发其它部位损伤(70.7%),16例出现多个椎体损伤,发生率为39.0%,与<60岁组比较差异均有显著性意义(P<0.05)。≥60岁组中神经功能发生A级损伤2例,B级损伤2例,C级损伤6例,D级损伤8例,神经功能正常(E级)的伤员有23例。发生复合伤的29例伤员中,并发肢体骨折20例,并发肋骨骨折11例,并发挤压综合征、肺挫裂伤、肠梗阻的伤员各有1例,并发两种以上复合伤5例。发生多个椎体损伤的部位以T12、L1、L2最多见,16例伤员中发生两个以上椎体压缩骨折10例,两个以上椎体爆裂骨折2例,1个椎体爆裂骨折及另1个椎体压缩骨折4例。结论汶川大地震老年人脊柱骨折类型以压缩骨折和爆裂骨折为主,其类型构成与中青年人差异有显著性意义;与中青年脊柱骨折伤员相比,老年人发生严重神经损伤的比例低,发生复合伤和多个椎体损伤的比例高。
Objective To analyze the constituent ratio and clinical characteristics of spine fractures caused by the 5.12 Wenchuan earthquake in early patients.Methods 119 patients were divided into two groups according to their ages,that is,those< 60 years old were in Group A(78 cases),and those ≥60 years old were in Group B(41 cases).The data on fracture patterns,extent of nervous lesions,combined injuries and multiple segmental spine fractures were collected.The clinical features of spine fractures between young or middle-aged people and elderly patients were analysed and compared.Results Compression fractures were dominant in ≥60 years old patients(48.8% of all fractures),followed by bursting fractures(46.3%).There were only 2 cases of fracture dislocation.The overall constituent ratio of the fracture pattern was significantly different with that of <60 years old patients.Grave nervous damage occurred in 10 patients and the ratio was 24.4%.29 patients were complicated by other injuries and the ratio was 70.7%.16 patients had multiple vertebral injuries and the ratio was 39.0%.In ≥ 60 years old patients,Grade A nervous damage was found in 2 cases,Grade B in 2 cases,Grade C in 6 cases,Grade D in 8 cases,and Grade E(normal nervous function) in 23 cases.Among the 29 patients with combined injuries,complicated by limb fractures were in 20 cases,rib fractures in 11 cases,crush syndrome in 1 case,lung contusion in 1,and intestinal obstruction in 1.Combined injuries of over two positions occurred in 5 cases.Among the patients inflicted with multiple vertebral fractures,T12,L1,and L2 vertebral fractures were mostly seen,in which 10 patients had more than two vertebral compression fractures,2 patients had more than two vertebral bursting fractures,4 patients had one vertebral bursting fracture and another vertebral compression fracture.Conclusion Compression and bursting fractures are dominant in the spine fractures of elderly patients from Wenchuan earthquake area.There is significant difference in the constituent ratio of the fracture pattern between old patients and young or middle-aged ones.In comparison with young or middle-aged patients,elderly patients have a low ratio of severe nervous damage,but a high ratio of combined injury and multiple vertebral injuries.
Objective To analyze the constituent ratio and clinical characteristics of spine fractures caused by the 5.12 Wenchuan earthquake in early patients.Methods 119 patients were divided into two groups according to their ages,that is,those< 60 years old were in Group A(78 cases),and those ≥60 years old were in Group B(41 cases).The data on fracture patterns,extent of nervous lesions,combined injuries and multiple segmental spine fractures were collected.The clinical features of spine fractures between young or middle-aged people and elderly patients were analysed and compared.Results Compression fractures were dominant in ≥60 years old patients(48.8% of all fractures),followed by bursting fractures(46.3%).There were only 2 cases of fracture dislocation.The overall constituent ratio of the fracture pattern was significantly different with that of <60 years old patients.Grave nervous damage occurred in 10 patients and the ratio was 24.4%.29 patients were complicated by other injuries and the ratio was 70.7%.16 patients had multiple vertebral injuries and the ratio was 39.0%.In ≥ 60 years old patients,Grade A nervous damage was found in 2 cases,Grade B in 2 cases,Grade C in 6 cases,Grade D in 8 cases,and Grade E(normal nervous function) in 23 cases.Among the 29 patients with combined injuries,complicated by limb fractures were in 20 cases,rib fractures in 11 cases,crush syndrome in 1 case,lung contusion in 1,and intestinal obstruction in 1.Combined injuries of over two positions occurred in 5 cases.Among the patients inflicted with multiple vertebral fractures,T12,L1,and L2 vertebral fractures were mostly seen,in which 10 patients had more than two vertebral compression fractures,2 patients had more than two vertebral bursting fractures,4 patients had one vertebral bursting fracture and another vertebral compression fracture.Conclusion Compression and bursting fractures are dominant in the spine fractures of elderly patients from Wenchuan earthquake area.There is significant difference in the constituent ratio of the fracture pattern between old patients and young or middle-aged ones.In comparison with young or middle-aged patients,elderly patients have a low ratio of severe nervous damage,but a high ratio of combined injury and multiple vertebral injuries.
引文
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[2]Gu K,Raymond V,Serhan T,et al.Acute renal failure due to crushsyndrome during Marmara earthquake[J].Am J Kidney Dis,2002,40(4):682-689.
[3]Iskit SH,Alpay H,Tugtepe H,et al.Analysis of 33 pediatric trauma vic-tims in the 1999 Marmara,Turkey earthquake[J].J Pediatr Surg,2001,36(2):368-372.
[4]Sheng ZY.Medical support in the Tangshan earthquake:a review of themanagement of mass casualties and certain major injuries[J].J Trauma,1987,27(3):1130-1135.
[5]Bulut M,Fedakar R,Akkose S,et al.Medical experience of a universityhospital in Turkey after the 1999 Marmara earthquake[J].Emerg Med J,2005,22(5):494-498.
[6]Roy DK,O’Neill TW,Finn JD,et al.Determinants of incident vertebralfacture in men and women:results from the European Prospective Osteo-porosis Study(EPUS)[J].Osteoporos Int,2003,14(1):19-26.
[7]Lane JM,Riley EH,Wirganowicz PZ.Osteoporosis:diagnosis and treat-ment[J].J Bone Joint Surg,1996,78A(6):618-632.
[8]Heggeness MH.Spine fracture with neurological deficit in osteoporosis[J].Osteoporos Int,1993,3(2):215-221.
[9]Arciero RA,Leung KYK,Pierce JH.Spontaneous unstable burst fractureof the thoracolumbar spine in osteoporosis[J].Spine,1989,14(2):114-117.
[10]Salomon C,Chopin D,Benoist M:Spinal compression:an exceptionalcomplication of spinal osteoporosis[J].Spine,1988,13(3):222-224.
[11]Peek-Asa C,Ramirez M,Shoaf K,et al.Population-based case-controlstudy of injury risk factors in the northridge earthquake[J].Annals ofEpidemiology,2002,12(7):525-526.
[12]Tanida N.What happened to elderly people in the great Hanshin earth-quake[J].BMJ,1996,313(12):1133-1135.
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